Towards Actualizing the Value Potential of Korea Health Insurance Review and Assessment (HIRA) Data as a Resource for Health Research: Strengths, Limitations, Applications, and Strategies for Optimal Use of HIRA Data

Abstract

Health Insurance and Review Assessment (HIRA) in South Korea, also called National Health Insurance (NHI) data, is a repository of claims data collected in the process of reimbursing healthcare providers. Under the universal coverage system, having fee-for-services covering all citizens in South Korea, HIRA contains comprehensive and rich information pertaining to healthcare services such as treatments, pharmaceuticals, procedures, and diagnoses for almost 50 million beneficiaries. This corpus of HIRA data, which constitutes a large repository of data in the healthcare sector, has enormous potential to create value in several ways: enhancing the efficiency of the healthcare delivery system without compromising quality of care; adding supporting evidence for a given intervention; and providing the information needed to prevent (or monitor) adverse events. In order to actualize this potential, HIRA data need to actively be utilized for research. Thus understanding this data would greatly enhance this potential. We introduce HIRA data as an important source for health research and provide guidelines for researchers who are currently utilizing HIRA, or interested in doing so, to answer their research questions. We present the characteristics and structure of HIRA data. We discuss strengths and limitations that should be considered in conducting research with HIRA data and suggest strategies for optimal utilization of HIRA data by reviewing published research using HIRA data.

Emerging trends of inflammatory bowel disease in South Korea: A nationwide population‐based study

“…The Health Insurance Review and Assessment Service (HIRA) operates under the Korean NHIS and contains the adjusted medical and pharmacy claims data for the entire Korean population . For this reason, its database has been used for many epidemiological studies .…”

“…The Health Insurance Review and Assessment Service (HIRA) operates under the Korean NHIS and contains the adjusted medical and pharmacy claims data for the entire Korean population. 9 For this reason, its database has been used for many epidemiological studies. 5 Specifically, the HIRA database provides data regarding each de-identified individual's sociodemographic characteristics (sex, age, and medical-aid program), health-care service information (e.g.…”

Deep phenotyping of 34,128 patients hospitalised with COVID-19 and a comparison with 81,596 influenza patients in America, Europe and Asia: an international network study

“…Meanwhile data from South Korea came from Health Insurance Review & Assessment (HIRA), a repository of national claims data which is collected in the process of reimbursing healthcare providers. [10] In addition, the feasibility of performing the analysis was considered for Tufts-Clinical Academic Research Enterprise Trust (CLARET), US, and the Daegu Catholic University Medical Center, a teaching hospital in Daegu, South Korea, covered by Federated E-health Big Data for Evidence Renovation Network (FEEDER-NET). These were not included, however, due to low numbers (less than 30 individuals with COVID-19 meeting the inclusion criteria).…”

Incidence and clinical impact of perianal disease in patients with ulcerative colitis: A nationwide population‐based study

“…This study was performed using the Korean National Health Insurance (NHI) and Health Insurance Review and Assessment Service (HIRA) claims databases. The South Korean government operates a universal NHI system that covers almost 98% of the total population . The HIRA database holds health care utilization information including demographic characteristics, history of hospitalization and outpatient care, principal diagnosis and comorbidities (with 10th International Classification of Diseases [ICD‐10] codes), prescriptions, medical procedures, and rare intractable disease (RID) registration information.…”